Basic Information
| Provider Information | |||||||||
| NPI: | 1336574649 | ||||||||
| EntityType: | 2 | ||||||||
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| OrganizationName: | RECOVERY ANESTHESIA, LLC | ||||||||
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| Mailing Information | |||||||||
| Address1: | 1896 PETUNIA ST | ||||||||
| Address2: | URBANIZACION SANTA MARIA | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 00927 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876028949 | ||||||||
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| Practice Location | |||||||||
| Address1: | 89 AVENIDA DE DIEGO STE. 105 | ||||||||
| Address2: | PMB 721 | ||||||||
| City: | SAN JUAN | ||||||||
| State: | PR | ||||||||
| PostalCode: | 009276346 | ||||||||
| CountryCode: | US | ||||||||
| TelephoneNumber: | 7876028949 | ||||||||
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| Other Information | |||||||||
| ProviderEnumerationDate: | 09/05/2013 | ||||||||
| LastUpdateDate: | 09/05/2013 | ||||||||
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| AuthorizedOfficialLastName: | RODRIGUEZ | ||||||||
| AuthorizedOfficialFirstName: | JOSE A | ||||||||
| AuthorizedOfficialMiddleName: | A | ||||||||
| AuthorizedOfficialTitleorPosition: | PRESIDENT | ||||||||
| AuthorizedOfficialTelephone: | 7876028949 | ||||||||
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| IsOrganizationSubpart: | N | ||||||||
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| AuthorizedOfficialNamePrefix: | DR. | ||||||||
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| AuthorizedOfficialCredential: | MD | ||||||||
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Taxonomy Information
| Taxonomy | License | State | Switch | TaxonomyGroup | TaxonomyType | TaxonomyClass | SubSpecialty | 207L00000X | 13248 | PR | Y | 193400000X SINGLE SPECIALTY GROUP | Allopathic & Osteopathic Physicians | Anesthesiology |
No ID Information.